What is psoriasis?
Psoriasis is a common autoimmune chronic skin condition that is characterized by scaly, red patches on the skin that are itchy.
These scaly patches on the skin are accumulated skin cells due to the increase in the speed of the life cycle of the skin cells.
The different types of psoriasis are:
What are the symptoms of psoriasis?
The symptoms of psoriasis vary from person to person.
However, common psoriasis symptoms include:
- Red patches or rashes covered with thick, dry, silvery scales. In some individuals, these patches coalesce to form bigger patches.
- The skin becomes itchy and painful and often bleeds.
- Bleeding can occur in patches where the scales are tightly attached to the underlying skin.
- Itching, burning, and soreness in on the patches.
- Pitting and discoloration of the finger and toenails. In severe cases, the nail begins to detach from the nail bed.
- The common areas that are affected by psoriatic patches include the scalp, arms, legs, palms, trunk, feet and palms.
The symptoms of psoriasis occur in cycle i.e the patches flare up in some months of the year and subside in the other.
In about 10-30% cases, psoriasis has been associated with psoriatic arthritis wherein the patient has swollen and aching joints along with the skin lesions.
What is the main cause of psoriasis?
The exact cause of psoriasis is unknown.
However, researchers till date have been able to point out that it occurs due to a misdirected immune system and the various environmental factors.
The immune system and your genes
In normal cases, the body’s immune system gets activated when a foreign body or particle enters the body.
However, in individuals with psoriasis, some genes that are defective and these cause inflammation on exposure to certain substances and trigger the skin cells to start multiplying.
There are about twenty-five genes that are suspected to cause psoriasis.
Also, there are more than one gene is speculated to cause the condition.
1 in every 10 people have these defect genes but only 2-3 of them actually develop the conditions.
Stress is one of the primary and the most important causative factor for many skin conditions, including psoriasis.
Though stress is a mental pressure, the body reacts to it in the same way as it does to physical pressure.
Thus, sudden, chronic and excessive stress levels can trigger psoriasis.
Psoriasis can flare-up due to hormonal changes in the body, especially around puberty, menopause, and pregnancy.
These three situations where there is a drastic change in the hormonal levels in the body.
Smoking is known to cause pustular psoriasis.
Individuals with a history of psoriasis are twice as likely to develop the condition if they smoke.
The lesions primarily appear on the palms and the soles of feet.
There are some medications that can trigger or make existing psoriasis worse.
These include antimalarials like chloroquine, hydroxychloroquine, and quinacrine, beta blockers, ACE inhibitors, and quinidine, indomethacin, and lithium in some medicines.
Some disease conditions like HIV and other infections like respiratory infections can also cause a flare-up of psoriasis.
Psoriasis: What’s the genetic link?
Researches have shown genetic factors to play a key role in the development of psoriasis.
There are many genes that are associated with psoriasis, which includes:
FUBP1 (Far Upstream Element Binding Protein 1) protein encodes a single-stranded DNA-binding protein that binds to multiple DNA elements and has a 3’-5’ helicase activity.
It binds to viral RNA is thought to play a role in the development of viral diseases.
Apoptosis or programmed cell death is now associated with the pathogenesis of many inflammatory skin disorders, including psoriasis.
The Fas or FasLigand gene (FASLG) is one of the best-known mechanisms for induction of apoptosis and is crucial in the onset of psoriasis, promoted by activated lymphocytes.
Fas-mediated cell-death prevents autoimmune reactions by removing the active T-cells from the medium, resulting in an immune reaction.
The single nucleotide polymorphisms of the Fas cell surface receptor gene and the Fas Ligand gene (FASLG) in the promoter region affect the expression of these genes and their serum levels.
These levels are important in patients with psoriasis.
This gene is located on chromosome 1q32.1.
The IKBKE (Inhibitor of Kappa light polypeptide gene enhancer in B-cells, Kinase Epsilon) is known as a psoriasis-related protein that is needed for the regulation of anti-viral and anti-inflammatory pathways.
In fact, the TNF- alpha that exists on the IKBKE upstream pathway has been used as a psoriasis drug target.
ZNF365 (Zinc Finger 365) gene codes for several isoforms, each of which has a different expression pattern and functions.
A mutation in this gene is associated with uric acid nephrolithiasis.
The gene is involved in the homologous recombination (HR) repair pathway and is required for the proper resolution of DNA by HR.
It also contributes to genomic stability by preventing telomere dysfunction.
PTEN (Phosphate and Tensin Homologue) gene is present on chromosome 10 and when it is deleted, it acts as a major tumor suppressor and inhibits cell proliferation through inactivation of the PI3 kinase(PI3K)/ Akt signal pathway.
The downregulation of the PTEN gene may play a role in the overactivation of the PI3K/ Akt signal pathway in psoriatic lesions and correlate with the excessive proliferation of the lesions.
The G allele of rs76959677 is said to be associated with psoriasis.
CHUK (Conserved Helix-Loop-Helix Ubiquitous Kinase) enzyme is involved in inhibiting the actions of NF-κB as it plays a role in its transcription.
Individuals with this SNP were associated with response to etanercept.
Inheritance of psoriasis
Psoriasis has a multifactorial pattern of inheritance, which means that it occurs due to a complex interplay between genetic and environmental factors.
The genes from both parents and environmental factors determine if the individual develops the condition or not.
However, there have been reports where the disease appears to have an autosomal dominant or autosomal recessive pattern of inheritance.
A research study conducted by Swanbeck et al calculated the lifetime risk of developing psoriasis in individuals with no parent, one parent and both parents having the condition.
The results did show an increased susceptibility in those with one or both parents having psoriasis.
Diet recommendation for psoriasis
Psoriasis cannot be cured completely.
However, the symptoms can be managed and flare-ups can be reduced using medications, lifestyle changes, and diet.
Though not scientifically conclusive, there has been considerable evidence to show that changing to a healthier diet can help reduce flare-ups and enable better management of the symptoms of psoriasis.
Some components of foods such as omega-3 fatty acids, antioxidants, and anti-inflammatory substances are said to be helpful to reduce flare-ups and help in better management of the condition.
Foods that help psoriasis include:
- Nuts and seeds
- Seafood, especially fishes that are rich in omega-3 fatty acids like salmon, mackerel, trout, etc.
- Blueberries and strawberries
- Spices such as peppermint, cinnamon, and cloves
- Herbs such as oregano, thyme, and sage
- Foods that are rich in vitamin D- cheese, yogurt, and eggs
- Fresh fruits and vegetables
While these are the foods that one must include to manage psoriasis, there are a host of other foods that need to be avoided to stay clear of a flare-up.
- Avoid processed foods
- Nightshade plants that contain solanine such as tomatoes, brinjal, peppers, and potatoes could be avoided
- Eliminate red meat, especially beef and also processed meats that are available today
- Avoid fried foods as they are known to cause inflammation in the body which triggers off a psoriatic flare-up
- Eliminate trans fats and other saturated fats from your diet completely. One can benefit from replacing saturated oils with healthy oils such as virgin olive oil.
- Stay away from excess sugars
- Avoid alcohol consumption
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Home remedies: What works?
There are multiple ways to reduce the symptoms and prevent flare-ups, and many of these are home remedies.
Avoid perfumes and deodorants
Perfumes, soaps, deodorants, shampoos, etc which have fragrances in them as they contain dyes.
The dyes in these fragrant products lead inflammation of the skin and cause a flare-up of psoriasis.
Before you choose a product, make sure it has a ‘sensitive’ label on it or consult your dermatologist for the right products for you.
Moisturizing your skin regularly
It helps to soothe the itchiness of the lesions.
People with psoriasis must make sure their skin never gets dry as it can lead to an increase in the lesions.
Avoid excessive exposure to sunlight as it can aggravate psoriatic lesions.
An individual with psoriasis must avoid stress, a primary cause of flare-ups.
Practicing stress-relieving methods can help manage psoriasis effectively.
Alcohol is a big-no for those suffering from psoriasis and so an individual with the condition must avoid consuming it.
Apply turmeric on the lesions, adding them to your food or consuming it as a pill, within limits (1.5-3 gms per day) has proven to be beneficial to those suffering from psoriasis.
Consuming adequate amounts of vitamins and minerals proves helpful to reduce the psoriatic lesions.
External application on the lesions using some herbal products is very helpful. These include aloe vera, apple cider vinegar, dead sea salts, oats, tea tree oil, and Oregon grape.
Is psoriasis contagious?
There is a misconception that psoriasis is infectious, however, it does not spread from one person to the other.
But it is quite common to see the lesions spread to other parts of the body.
In many cases, the lesions also coalesce to form larger lesions.
There are many ways to prevent the spread of psoriasis in an individual, but it also depends upon the type of psoriasis.
Plaque psoriasis, which the most common type that affects people spreads to elbows, knees, and scalp.
A rare type of psoriasis known as erythrodermic psoriasis is a more dangerous form which spread to all parts of the body.
In many instances, people with one type of psoriasis can develop another type of disease.
If left untreated, psoriasis lesions can spread and become more intense.
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